卷 14, 编号 4 (2021)

BACKGROUND: To date, there is a number of debatable aspects of cataract phacoemulsification in the literature, one of which is the investigation of features of the surgery in patients with visually stressful work.

AIM: The aim is to investigate the dynamics of the best corrected distance visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification.

MATERIALS AND METHODS: We observed 32 heavy visual workload patients with binocular cataracts. All patients underwent standard phacoemulsification using Infiniti (Alcon, USA) or Constellation (Alcon, USA) devices according to the standard technique. The quality of life was assessed using the tested in refractive surgery QOL-25 questionnaire.

RESULTS: The high efficiency of phacoemulsification surgery was established, which is confirmed (14 days after the second procedure) by an increase in best corrected distance visual acuity to an average value of 0.92–0.95 relative units. Along with this, a certain quality of life dynamics of was revealed, which is manifested by a statistically significant deterioration (by 2.3–4.7%, p = 0.02–0.008) in the index in 14 and 21 days after the first surgical procedure compared to the data obtained at 7 days after first operation.

CONCLUSION: Surgical treatment of binocular cataracts in heavy visual workload patients is based on earlier (in 7–10 days) surgery on the second eye or performing an immediately sequential bilateral cataract surgery.

课题迫切性：近年来针对黄斑裂孔患者的治疗越来越多的采用自体血浆疗法。在这项研究中，对通过不同方法获取的自体血浆进行了生物分析。

研究目的：对比不同方法所获取的用于治疗黄斑裂孔患者自体血浆的细胞和生化成分。

材料和方法：对24名患者血浆中的血小板、白细胞和纤维蛋白原的数量进行了研究，该血浆成分通过原始自体血浆收集系统和实验室试管离心法获取。

结果：通过对比Arthrex ACP制备器和实验室试管获取的P-PRP值，血小板和纤维蛋白的数值在统计学上无显著差异（p<0.05），白细胞的数量在统计学上有显著差异（p>0.05）,实验室试管的基质中白细胞数量增加。通过对比Ycellbio-Kit制备器和实验室试管得到的L-PRP值，纤维蛋白原的数量在统计学上无差异（p<0.05），白细胞和血小板的含量在统计学上有显著差异（p>0.05），实验室试管得到的自体血浆浓度低。

结论：目前通过Arthrex ACP制备器获取的自体血浆由于其极少的白细胞含量、系统密封性以及所得基质具有更好的凝固特性在黄斑裂孔外科治疗中备受关注。实验室试管被认为是获取用于治疗黄斑裂孔的自体血浆（P-PRP）更实惠的替代方案。通过Ycellbio-Kit制备器和实验室试管获取的自体血浆（L-PRP）在成分上不太适用于黄斑裂孔的外科治疗。

课题迫切性：许多形式的儿童青光眼并没有手术治疗的最佳方法。在这种情况以及难治性青光眼的情况下，当手术干预没有效果的时候，植入各种类型的引流装置可能是首选手术。

目的：评估Ahmed青光眼阀植入术对儿童难治性青光眼的有效性。

材料和方法：分析了52名年龄在1个月至17岁（6.6±0.6岁）的儿童（67只眼睛）因原发性先天性青光眼、眼球先天性异常的青光眼、继发性青光眼手术不成功的治疗结果。手术治疗成功的标准是眼压稳定正常，没有并发症以及无需重复干预。

结果：97%的患者在6个月内保持手术效果，但在1年、2年和3年后分别下降到91.8%、82%和73.9%， 7年后下降到42.8%。术后并发症包括滤过泡包裹（25.3%），虹膜回缩至引流管合并瞳孔异位（4.5%），睫状体脉络膜脱落（4.5%），白内障（3.0%），结膜糜烂及引流管暴露（4.5%），眼内炎（1.5%），视网膜脱落（6.0%），引流管回缩（1.5%），眼前房积血（3.0%）。导致不良后果的风险因素是眼前后轴与正常年龄的标准值相比增加20%或更多，手术时眼压超过32毫米汞柱，以及以前做过滤性抗青光眼手术。

结论：植入Ahmed青光眼阀适用于以前手术失败的难治性小儿青光眼。然而有必要考虑到该装置的效果会随着时间的推移而下降，再加上有可能出现并发症，因此需要对患者进行长期的动态观察。

非自杀性自残发生在所有专业的医生实践中。本文将介绍一名接受手术治疗的人为性皮炎和眼睑闭合不全患者的临床病例。

BACKGROUND: Strabismus as a pathological condition complicating the visual function and affecting the behavioral functions of children is often in the center of attention of numerous studies. The presence of regional differences in the strabismus prevalence makes this problem a relevant to study issue in the regions of Azerbaijan.

AIM: To assess the prevalence rate of strabismus among children depending on the settlement type.

MATERIALS AND METHODS: A prospective observation of a sample of children aged 5–19 years was carried out; the sample size was determined taking into account the size of the margin of sampling error less than 5%. 300 children at the age 5–9, 10–14, 15–19 years (150 boys and 150 girls) in a large town (Ganja) and rural settlements of Ganja-Gazakh region (2700 children in total) have been observed. In all children, an ophthalmologic examination was performed by specialists of the mobile team of the National Ophthalmological Center named after academician Z. Aliyeva.

RESULTS: Strabismus was found in children aged 5-19 years in 4.6 ± 0.7% of cases in a large town and in 2.7 ± 0.5% of cases in rural settlements. Significant differences of prevalence rate of strabismus by age and gender were not confirmed.

CONCLUSIONS: In the region, the incidence of strabismus among children aged 5–19 years was 3.8 ± 0.4%. In a large town, the risk of strabismus among children is high. In children with strabismus, refractive errors and perinatal conditions (prematurity) are often found.

Recurrent corneal erosion (RCE) is a common recurrent disease caused by abnormal adhesion of the corneal epithelium to the basement membrane. Previous corneal trauma is the most common cause of this disease. Corneal dystrophies, such as dystrophy of the epithelial basement membrane, Meesmann dystrophy, Reis–Bücklers dystrophy, lattice dystrophy and granular dystrophies, are also involved in the pathogenesis of recurrent corneal erosion. The main diagnostic methods for recurrent corneal erosion are slit-lamp examination and taking of medical history. Detectable RCE changes range from small corneal irregularities (such as epithelial microcysts) to large areas of loose epithelium or epithelial defects detecting by fluorescein staining. Areas of irregular epithelium with grayish inclusions or microcysts and a “fingerprint” pattern or a map-like defects are also revealed. The main goal of treatment is to relieve pain, stimulate re-epithelialization, and fully restore the adhesion of the basement membrane and epithelium. Lubricants and matrix proteinase inhibitors are prescribed as first-line therapy, and blood derivatives can be used as second-line therapy. When conservative therapy fails, surgical procedures are used (excimer laser phototherapeutic keratectomy, Bowman’s membrane polishing with diamond drill, anterior stromal puncture, corneal collagen cross-linking).

BACKGROUND: Development and testing of drugs with regenerative and anti-inflammatory properties. It is advisable using them in keratopathy development and impairments of trophic processes, at the action of preservatives against the background of long-term local IOP-lowering therapy for glaucoma, as well as in the presence of a surgical wound in the area of the procedure, the last causing discomfort in many patients, foreign body sensation, and ocular irritation during the postoperative period in glaucoma treatment.

AIM: To evaluate the effect of ophthalmic drug films (ODF) with 6-methyl-3- (thietan-3-yl)uracil and methyluracil on the thickness of the corneal epithelium after experimental chemical burn.

MATERIALS AND METHODS: A histomorphological analysis of the cornea of 17 rabbits (34 eyes) of the Chinchilla breed after experimental chemical burn was carried out, the wound healing and keratoprotective properties of ophthalmic drug films were evaluated. Ophthalmic drug films with 6-methyl-3-(thietan-3-yl)uracil were placed in right eyes of 15 rabbits, and those with methyluracil were placed in left eyes of same rabbits. Two rabbits (4 eyes) served as control: their right eyes were left without wound healing therapy, while left eyes received dexpanthenol 5% gel (Corneregel) 4 times a day. The animals were followed-up for 21 days, morphological changes in the cornea were assessed on the 2^nd, 7^th, 14^th and 21^st days of the study.

RESULTS: Different results were obtained depending on the ODF used. The use of ODF with methyluracil on days 2–7 led to an increase in the thickness and the number of epithelial layers compared to ophthalmic drug films with 6-methyl-3-(thietan-3-yl)uracil, where epithelial reactivity was observed by 14 days. On the 21^st day of follow-up, the microscopic picture of the cornea in the right and the left eyes was characterized by total restoration and healing of the corneal epithelium.

CONCLUSIONS: Ophthalmic drug films therapy with methyluracil and 6-methyl-3-(thietan-3-yl)uracil leads to histologically correct and rapid epithelialization of the cornea after a chemical burn.

主编对Potemkin V.V., Marchenko O.A., Goltsman E.V., Anikina L.K., Gladysheva E.K. 的文章"复杂临床病例—眼科医生实践中的人为性皮炎"的评述，2021年。Vol.14,No.4。

BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period.

AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients.

MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts.

RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was “absence of an ophthalmologist in the outpatient polyclinic”. The patient’s lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm – 37.2%; pseudoexfoliation syndrome – 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber – 44.8%; lens subluxation – 24.1%; atrophy of the pupillary margin – 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively – 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one – 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 ± 0.27, on Day 7 – 0.73 ± 0.22, after 3 months – 0.76 ± 0.25.

CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.

In the article, data on creative activity and personality of the Professor in ophthalmology Pavel Efremovich Tikhomirov are presented. Under the guidance of Academician M.I. Averbakh in the Helmholtz Moscow research institute of eye diseases, Pavel Efremovich raised through the ranks from a medical extern to Senior research fellow, Professor, Vice-Director of the institute. From 1945 to the end of his life (1964), he was the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene (currently the North-Western State Medical University named after I.I. Mechnikov). P.E. Tikhomirov took part in two wars: in 1919–1922 served in the Red Army in the position of a regimental doctor, during the Great Patriotic War, he was a Head ophthalmologist of a Hospital Administration of the Ministry of Health of the Russian Federation (he organized and headed the military hospital department in Moscow, took multiple missions to evacuation hospitals of the country).

Main scientific activities of P.E. Tikhomirov: problems of the military ocular injuries, diagnosis and treatment of lacrimal system diseases, glaucoma, pre-glaucoma, and ocular tuberculosis. His writings include three monographies, two sections of the multi-volume edition on eye diseases, more than 100 scientific articles, a compendium of scientific articles “Glaucoma” (1960).

Pavel Efremovich was an experienced organizer and a good psychologist. He began teaching Ophthalmology in 1933 in two Moscow institutes of higher education. During 1945–1964, being the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene, excellent teacher and lecturer, very good clinician, Professor P.E. Tikhomirov prepared hundreds of ophthalmologists, 6 candidates of medical sciences, was a consulting specialist of three doctorate theses.

Real professional and clinician, outstanding ophthalmic surgeon, Professor P.E. Tikhomirov during 45 years of his medical career recovered the sight of many thousands of patients and was widely well-known not only in Leningrad, but in the whole country.